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Duggan C, Hernon O, Dunne R, McInerney V, Walsh SR, Lowery A, McCarthy M, Carr PJ. Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review. Crit Rev Oncol Hematol 2024; 196:104277. [PMID: 38492760 DOI: 10.1016/j.critrevonc.2024.104277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.
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Affiliation(s)
- C Duggan
- Department of Oncology, Portiuncula Hospital, Ballinasloe, Galway H53 T971, Ireland; School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia.
| | - O Hernon
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| | - R Dunne
- Library, University of Galway, Ireland
| | - V McInerney
- HRB Clinical Research Facility, University of Galway, Ireland
| | - S R Walsh
- Department of Vascular Surgery, Galway University Hospital, Ireland
| | - A Lowery
- School of Medicine, University of Galway, Ireland
| | - M McCarthy
- Department of Medical Oncology, Galway University Hospital, Ireland
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
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Sharp R, Xu Q, Pumpa R, Elliott L, Corsini N, Marker J, Altschwager J, Ortmann A, Turner L, Jin L, Ullman A, Esterman A. Supportive care needs of adults living with a peripherally inserted central catheter (PICC) at home: a qualitative content analysis. BMC Nurs 2024; 23:4. [PMID: 38163877 PMCID: PMC10759691 DOI: 10.1186/s12912-023-01614-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are common vascular access devices inserted for adults undergoing intravenous treatment in the community setting. Individuals with a PICC report challenges understanding information and adapting to the device both practically and psychologically at home. There is a lack of research investigating the supportive care needs of individuals with a PICC to inform nursing assessment and the provision of additional supports they may require to successfully adapt to life with a PICC. The aim of this study was to identify the supportive care needs of adults with cancer or infection living with a PICC at home. METHOD Qualitative, semi-structured interviews were used to identify supportive care needs of adults living with a PICC at home. Participants were recruited from cancer and infectious diseases outpatient units. Two researchers independently analysed transcripts using content analysis. RESULTS A total of 15 participants were interviewed (30-87 years old). There were 5 males and 10 females interviewed, 9 participants had a cancer diagnosis and most lived in a metropolitan area. Many participants lived with a partner/spouse at home and three participants had young children. Participants identified supportive care needs in the following eight categories (i (i) Adapting daily life (ii) Physical comfort (iii) Self-management (iv) Emotional impact (v) Information content (vi) Understanding information (vii) Healthcare resources and (viii) Social supports. CONCLUSIONS Adults living with a PICC at home report a broad range of supportive care needs. In addition to practical and information needs, health consumers may also require support to accept living with a device inside their body and to assume responsibility for the PICC. These findings may provide nurses with a greater understanding of individual needs and guide the provision of appropriate supports.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia.
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Robyn Pumpa
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Lisa Elliott
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Julie Marker
- Cancer Voices South Australia, Adelaide, Australia
| | | | - Alanna Ortmann
- Metropolitan Referral Unit, SA Health, Adelaide, Australia
| | | | - Lili Jin
- South Australia Medical Imaging (SAMI)/ Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Adrian Esterman
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
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Sharp R, Xu Q, Corsini N, Turner L, Altschwager J, Marker J, Ullman A, Esterman A. Community-based Intravenous Treatment and Central Venous Access Devices: A Scoping Review of the Consumer and Caregiver Experience, Information Preferences, and Supportive Care Needs. J Community Health Nurs 2023; 40:28-51. [PMID: 36602775 DOI: 10.1080/07370016.2022.2081506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Map existing research and describe the consumer/caregiver experience of community-based intravenous treatment, central venous access devices (CVADs), supportive care needs, and information preferences. DESIGN Scoping review. METHODS Five databases (Joanna Briggs Institute, Cochrane library, Emcare, Embase, and Medline) were searched. Screening and data extraction were performed independently by two reviewers. FINDINGS Forty-eight studies were included. CONCLUSIONS Although community-based intravenous treatment and CVADs have a significant impact on consumers and caregivers, there is scant research on their supportive care needs and information preferences. CLINICAL EVIDENCE Some consumers and caregivers may require additional support while undergoing community-based intravenous treatment.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.,Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Lisa Turner
- Clinical Operations, Silver Chain Group, Australia
| | | | - Julie Marker
- Cancer Voices South Australia, Adelaide, Australia
| | - Amanda Ullman
- Children's Health Queensland and Health Service/ School of Nursing, Midwifery and Social Work, The University of Queensland, Australia
| | - Adrian Esterman
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.,Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
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Sheng Y, Wu T, Fan C, Hao H, Gao W. Factors influencing the optimal selection of central venous access devices: A qualitative study of health care team members' perspectives. Int J Nurs Sci 2022; 9:445-452. [PMID: 36285077 PMCID: PMC9587387 DOI: 10.1016/j.ijnss.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/09/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to explore health care team members' understanding of the factors influencing the optimal selection of central venous access devices (CVADs). Methods The data of the study was collected using semi-structured interviews. Twenty-six hospital medical staff (four hospital manager, 15 head nurses, 7 nurse) with experience in peripheral or central catheterization from four regions (Northern China, Southern China, Northwest China, and Qinghai-Tibet China) in China were interviewed between June and October 2021. Content analysis was used to analyze the data. Results The results revealed five themes and 14 sub-themes. Patients: concerns, resources, requirements, and evaluation (security concerns, support resources, life requirements, evaluation among patients); nurses: awareness, knowledge, and popularizing methods (awareness of intravenous therapy, understanding of professional knowledge, forms of popularizing methods); doctors: support and involvement (support for decision-making, involvement in intravenous work); hospital managers: authority, quality control and continuing education (management of catheterization authority, quality control of intravenous infusion, investment in continuing education) and environment: differences and commonalities (differences in social support, and current commonalities). Conclusion Nurses and other healthcare team members' understanding, selection, use, and recommendation of CVADs have an indirect effect on patients' decision-making. Therefore, hospital managers and government departments can indirectly strengthen medical team cooperation and improve learning education in order to improve the safety of patients receiving intravenous infusions.
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Affiliation(s)
- Yuan Sheng
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Tinglan Wu
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Chunmei Fan
- School of Nursing and Rehabilitation, Shandong University, Jinan, China
| | - Haixia Hao
- Department of PICCs Clinic, Qilu Hospital, Shandong Univerisity, Jinan, China
| | - Wei Gao
- Department of PICCs Clinic, Qilu Hospital, Shandong Univerisity, Jinan, China
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Elfeky A, Treweek S, Hannes K, Bruhn H, Fraser C, Gillies K. Using qualitative methods in pilot and feasibility trials to inform recruitment and retention processes in full-scale randomised trials: a qualitative evidence synthesis. BMJ Open 2022; 12:e055521. [PMID: 35437247 PMCID: PMC9016401 DOI: 10.1136/bmjopen-2021-055521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/28/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To systematically review published pretrial qualitative research studies and explore how their findings were used to inform recruitment and retention processes in full-scale trials. DESIGN Qualitative evidence synthesis using thematic analysis. DATA SOURCES AND ELIGIBILITY CRITERIA We conducted a comprehensive search of databases; Dissertation Abstracts International, CINAHL, Embase, MEDLINE, Sociological Abstracts and PsycINFO. We included all reports of pretrial qualitative data on recruitment and retention in clinical trials up to March 2018. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data using a predefined data extraction form that captured study aims, design, methodological approach and main findings, including barriers and facilitators to recruitment and or retention. The synthesis was undertaken using Thomas and Harden's thematic synthesis method and reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Confidence was assessed using Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. RESULTS Thirty-five papers (connected to 31 feasibility studies) from three different countries, published between 2010 and 2017 were included. All studies were embedded in pilot or feasibility studies to inform design aspects in preparation for a subsequent full-scale trial. Twelve themes were identified as recruitment barriers and three as recruitment facilitators. Two themes were identified as barriers for retention and none as retention facilitators. The findings from qualitative research in feasibility or pilot trials are often not explicitly linked to proposed changes to the recruitment and retention strategies to be used in the future or planned full-scale trial. CONCLUSIONS Many trial teams do pretrial qualitative work with the aim of improving recruitment and retention in future full-scale trials. Just over half of all reports of such work do not clearly show how their findings will change the recruitment and retention strategy of the future trial. The scope of pretrial work needs to expand beyond looking for problems and also look for what might help and spend more time on retention.
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Affiliation(s)
- Adel Elfeky
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Karin Hannes
- Research Group SoMeTHin'K, Faculty of Social Sciences, KU Leuven, Leuven, Belgium
| | - Hanne Bruhn
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Ivziku D, Gualandi R, Pesce F, De Benedictis A, Tartaglini D. Adult oncology patients' experiences of living with a central venous catheter: a systematic review and meta-synthesis. Support Care Cancer 2022; 30:3773-3791. [PMID: 35031831 DOI: 10.1007/s00520-022-06819-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The incidence of cancer is increasing globally, and a greater number of patients will receive treatments though central vascular access devices (CVADs). Only a few qualitative studies describe the experience of adult oncology patients living with CVADs, and no systematic review of literature has been published on this topic. We therefore aimed to systematically synthesize the evidence of the qualitative studies on the experience of adult oncology patients with CVADs to report the implications of living with this device, and to inform healthcare professionals (HCPs) about problematic aspects of care for this population. METHODS A comprehensive literature review was conducted on PUBMED, MEDLINE, SCOPUS, COCHRANE, and WEB OF SCIENCE, and was updated on May 25, 2021. Nine studies fulfilled the inclusion criteria. The evidence was synthesized using the meta-aggregation approach proposed by the Joanna Briggs Institute. RESULTS Four themes emerged: During catheter implantation oncology patients typically experience reluctance, apprehension and acceptance; The nature of the information, knowledge transmission and HCPs' competence all influence the patient's confidence; How the presence of a catheter impacts the patient's daily life, their self-perception and their social behavior; The catheter is a symbol of disease, a friend that helps prevent problems, and its removal is perceived as physical and psychological liberation. CONCLUSION This systematic review evidenced some problematic aspects related to patient information, education and device management, and gaps in nursing skills on handling the device. The results of this review should be used as a framework for improvement interventions.
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Affiliation(s)
- Dhurata Ivziku
- Department of Nursing Innovation and Development, Campus Bio-Medico of Rome University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Raffaella Gualandi
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | | | - Anna De Benedictis
- Department of Clinical affairs, Campus Bio-Medico of Rome University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Daniela Tartaglini
- Department of Health Professions, Campus Bio-Medico of Rome University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Schults JA, Woods C, Cooke M, Kleidon T, Marsh N, Ray-Barruel G, Rickard CM. Healthcare practitioner perspectives and experiences regarding vascular access device data: An exploratory study. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1721750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jessica A. Schults
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
- Department of Anaesthesia and Pain Management, Queensland Children’s Hospital, Queensland, Australia
| | - Christine Woods
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
| | - Tricia Kleidon
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- Department of Anaesthesia and Pain Management, Queensland Children’s Hospital, Queensland, Australia
| | - Nicole Marsh
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland Australia
- School of Nursing and Midwifery, Griffith University, Queensland Australia
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Kelly LJ, Snowden A. 'Pinholes in my arms': the vicious cycle of vascular access. ACTA ACUST UNITED AC 2021; 30:S4-S13. [PMID: 34288751 DOI: 10.12968/bjon.2021.30.14.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD). AIMS To explore how patients make sense of living with a CVAD. METHODS This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author. FINDINGS Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence. CONCLUSION Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually 'embodied' by them.
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Affiliation(s)
| | - Austyn Snowden
- Chair in Mental Health, School of Health and Social Care, Edinburgh Napier University
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Moss JG, Wu O, Bodenham AR, Agarwal R, Menne TF, Jones BL, Heggie R, Hill S, Dixon-Hughes J, Soulis E, Germeni E, Dillon S, McCartney E. Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial. Lancet 2021; 398:403-415. [PMID: 34297997 DOI: 10.1016/s0140-6736(21)00766-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hickman-type tunnelled catheters (Hickman), peripherally inserted central catheters (PICCs), and totally implanted ports (PORTs) are used to deliver systemic anticancer treatment (SACT) via a central vein. We aimed to compare complication rates and costs of the three devices to establish acceptability, clinical effectiveness, and cost-effectiveness of the devices for patients receiving SACT. METHODS We did an open-label, multicentre, randomised controlled trial (Cancer and Venous Access [CAVA]) of three central venous access devices: PICCs versus Hickman (non-inferiority; 10% margin); PORTs versus Hickman (superiority; 15% margin); and PORTs versus PICCs (superiority; 15% margin). Adults (aged ≥18 years) receiving SACT (≥12 weeks) for solid or haematological malignancy from 18 oncology units in the UK were included. Four randomisation options were available: Hickman versus PICCs versus PORTs (2:2:1), PICCs versus Hickman (1:1), PORTs versus Hickman (1:1), and PORTs versus PICCs (1:1). Randomisation was done using a minimisation algorithm stratifying by centre, body-mass index, type of cancer, device history, and treatment mode. The primary outcome was complication rate (composite of infection, venous thrombosis, pulmonary embolus, inability to aspirate blood, mechanical failure, and other) assessed until device removal, withdrawal from study, or 1-year follow-up. This study is registered with ISRCTN, ISRCTN44504648. FINDINGS Between Nov 8, 2013, and Feb 28, 2018, of 2714 individuals screened for eligibility, 1061 were enrolled and randomly assigned, contributing to the relevant comparison or comparisons (PICC vs Hickman n=424, 212 [50%] on PICC and 212 [50%] on Hickman; PORT vs Hickman n=556, 253 [46%] on PORT and 303 [54%] on Hickman; and PORT vs PICC n=346, 147 [42%] on PORT and 199 [58%] on PICC). Similar complication rates were observed for PICCs (110 [52%] of 212) and Hickman (103 [49%] of 212). Although the observed difference was less than 10%, non-inferiority of PICCs was not confirmed (odds ratio [OR] 1·15 [95% CI 0·78-1·71]) potentially due to inadequate power. PORTs were superior to Hickman with a complication rate of 29% (73 of 253) versus 43% (131 of 303; OR 0·54 [95% CI 0·37-0·77]). PORTs were superior to PICCs with a complication rate of 32% (47 of 147) versus 47% (93 of 199; OR 0·52 [0·33-0·83]). INTERPRETATION For most patients receiving SACT, PORTs are more effective and safer than both Hickman and PICCs. Our findings suggest that most patients receiving SACT for solid tumours should receive a PORT within the UK National Health Service. FUNDING UK National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Jonathan G Moss
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
| | - Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Roshan Agarwal
- Department of Oncology, Northampton General Hospital, Northampton, UK
| | - Tobias F Menne
- Department of Haematology, The Freeman Hospital, Newcastle upon Tyne, UK
| | - Brian L Jones
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Steve Hill
- Procedure Unit, The Christie NHS Foundation Trust, Withington, UK
| | - Judith Dixon-Hughes
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Eileen Soulis
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Evi Germeni
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Elaine McCartney
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Wu O, McCartney E, Heggie R, Germeni E, Paul J, Soulis E, Dillon S, Ryan C, Sim M, Dixon-Hughes J, Agarwal R, Bodenham A, Menne T, Jones B, Moss J. Venous access devices for the delivery of long-term chemotherapy: the CAVA three-arm RCT. Health Technol Assess 2021; 25:1-126. [PMID: 34318743 DOI: 10.3310/hta25470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Venous access devices are used for patients receiving long-term chemotherapy. These include centrally inserted tunnelled catheters or Hickman-type devices (Hickman), peripherally inserted central catheters (PICCs) and centrally inserted totally implantable venous access devices (PORTs). OBJECTIVES To evaluate the clinical effectiveness, safety, cost-effectiveness and acceptability of these devices for the central delivery of chemotherapy. DESIGN An open, multicentre, randomised controlled trial to inform three comparisons: (1) peripherally inserted central catheters versus Hickman, (2) PORTs versus Hickman and (3) PORTs versus peripherally inserted central catheters. Pre-trial and post-trial qualitative research and economic evaluation were also conducted. SETTING This took place in 18 UK oncology centres. PARTICIPANTS Adult patients (aged ≥ 18 years) receiving chemotherapy (≥ 12 weeks) for either a solid or a haematological malignancy were randomised via minimisation. INTERVENTIONS Hickman, peripherally inserted central catheters and PORTs. PRIMARY OUTCOME A composite of infection (laboratory confirmed, suspected catheter related and exit site infection), mechanical failure, venous thrombosis, pulmonary embolism, inability to aspirate blood and other complications in the intention-to-treat population. RESULTS Overall, 1061 participants were recruited to inform three comparisons. First, for the comparison of peripherally inserted central catheters (n = 212) with Hickman (n = 212), it could not be concluded that peripherally inserted central catheters were significantly non-inferior to Hickman in terms of complication rate (odds ratio 1.15, 95% confidence interval 0.78 to 1.71). The use of peripherally inserted central catheters compared with Hickman was associated with a substantially lower cost (-£1553) and a small decrement in quality-adjusted life-years gained (-0.009). Second, for the comparison of PORTs (n = 253) with Hickman (n = 303), PORTs were found to be statistically significantly superior to Hickman in terms of complication rate (odds ratio 0.54, 95% confidence interval 0.37 to 0.77). PORTs were found to dominate Hickman with lower costs (-£45) and greater quality-adjusted life-years gained (0.004). This was alongside a lower complications rate (difference of 14%); the incremental cost per complication averted was £1.36. Third, for the comparison of PORTs (n = 147) with peripherally inserted central catheters (n = 199), PORTs were found to be statistically significantly superior to peripherally inserted central catheters in terms of complication rate (odds ratio 0.52, 95% confidence interval 0.33 to 0.83). PORTs were associated with an incremental cost of £2706 when compared with peripherally inserted central catheters and a decrement in quality-adjusted life-years gained (-0.018) PORTs are dominated by peripherally inserted central catheters: alongside a lower complications rate (difference of 15%), the incremental cost per complication averted was £104. The qualitative work showed that attitudes towards all three devices were positive, with patients viewing their central venous access device as part of their treatment and recovery. PORTs were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships. The main limitation was the lack of adequate power (54%) in the non-inferiority comparison between peripherally inserted central catheters and Hickman. CONCLUSIONS In the delivery of long-term chemotherapy, peripherally inserted central catheters should be considered a cost-effective option when compared with Hickman. There were significant clinical benefits when comparing PORTs with Hickman and with peripherally inserted central catheters. The health economic benefits were less clear from the perspective of incremental cost per quality-adjusted life-years gained. However, dependent on the willingness to pay, PORTs may be considered to be cost-effective from the perspective of complications averted. FUTURE WORK The deliverability of a PORTs service merits further study to understand the barriers to and methods of improving the service. TRIAL REGISTRATION This trial is registered as ISRCTN44504648. FUNDING This project was funded by the National Institute for Health Research (NHIR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 47. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elaine McCartney
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Evi Germeni
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James Paul
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Eileen Soulis
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Caoimhe Ryan
- School of Social Sciences, University of Dundee, Dundee, UK
| | - Moira Sim
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Judith Dixon-Hughes
- Cancer Research UK Glasgow Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Tobias Menne
- Haematology, Newcastle Freeman Hospital, Newcastle upon Tyne, UK
| | - Brian Jones
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Jonathan Moss
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Houghton C, Dowling M, Meskell P, Hunter A, Gardner H, Conway A, Treweek S, Sutcliffe K, Noyes J, Devane D, Nicholas JR, Biesty LM. Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 10:MR000045. [PMID: 33026107 PMCID: PMC8078544 DOI: 10.1002/14651858.mr000045.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Randomised trials (also referred to as 'randomised controlled trials' or 'trials') are the optimal way to minimise bias in evaluating the effects of competing treatments, therapies and innovations in health care. It is important to achieve the required sample size for a trial, otherwise trialists may not be able to draw conclusive results leading to research waste and raising ethical questions about trial participation. The reasons why potential participants may accept or decline participation are multifaceted. Yet, the evidence of effectiveness of interventions to improve recruitment to trials is not substantial and fails to recognise these individual decision-making processes. It is important to synthesise the experiences and perceptions of those invited to participate in randomised trials to better inform recruitment strategies. OBJECTIVES To explore potential trial participants' views and experiences of the recruitment process for participation. The specific objectives are to describe potential participants' perceptions and experiences of accepting or declining to participate in trials, to explore barriers and facilitators to trial participation, and to explore to what extent barriers and facilitators identified are addressed by strategies to improve recruitment evaluated in previous reviews of the effects of interventions including a Cochrane Methodology Review. SEARCH METHODS We searched the Cochrane Library, Medline, Embase, CINAHL, Epistemonikos, LILACS, PsycINFO, ORRCA, and grey literature sources. We ran the most recent set of searches for which the results were incorporated into the review in July 2017. SELECTION CRITERIA We included qualitative and mixed-methods studies (with an identifiable qualitative component) that explored potential trial participants' experiences and perceptions of being invited to participate in a trial. We excluded studies that focused only on recruiters' perspectives, and trials solely involving children under 18 years, or adults who were assessed as having impaired mental capacity. DATA COLLECTION AND ANALYSIS Five review authors independently assessed the titles, abstracts and full texts identified by the search. We used the CART (completeness, accuracy, relevance, timeliness) criteria to exclude studies that had limited focus on the phenomenon of interest. We used QSR NVivo to extract and manage the data. We assessed methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We used thematic synthesis to analyse and synthesise the evidence. This provided analytical themes and a conceptual model. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. Our findings were integrated with two previous intervention effectiveness reviews by juxtaposing the quantitative and qualitative findings in a matrix. MAIN RESULTS We included 29 studies (published in 30 papers) in our synthesis. Twenty-two key findings were produced under three broad themes (with six subthemes) to capture the experience of being invited to participate in a trial and making the decision whether to participate. Most of these findings had moderate to high confidence. We identified factors from the trial itself that influenced participation. These included how trial information was communicated, and elements of the trial such as the time commitment that might be considered burdensome. The second theme related to personal factors such as how other people can influence the individual's decision; and how a personal understanding of potential harms and benefits could impact on the decision. Finally, the potential benefits of participation were found to be key to the decision to participate, namely personal benefits such as access to new treatments, but also the chance to make a difference and help others. The conceptual model we developed presents the decision-making process as a gauge and the factors that influence whether the person will, or will not, take part. AUTHORS' CONCLUSIONS This qualitative evidence synthesis has provided comprehensive insight into the complexity of factors that influence a person's decision whether to participate in a trial. We developed key questions that trialists can ask when developing their recruitment strategy. In addition, our conceptual model emphasises the need for participant-centred approaches to recruitment. We demonstrated moderate to high level confidence in our findings, which in some way can be attributed to the large volume of highly relevant studies in this field. We recommend that these insights be used to direct or influence or underpin future recruitment strategies that are developed in a participant-driven way that ultimately improves trial conduct and reduces research waste.
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Affiliation(s)
- Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Aislinn Conway
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katy Sutcliffe
- Department of Social Science, Social Science Research Unit, UCL Institute of Education, London, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jane R Nicholas
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Kelly L, Snowden A. How to synthesise original findings back into the literature: a reintroduction to concurrent analysis. Nurse Res 2020; 28:32-37. [PMID: 32351078 DOI: 10.7748/nr.2020.e1710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND All studies need to integrate their findings back into the literature to explain how the new knowledge changes understanding. This process can be anxiety-provoking, especially when new literature appears to threaten the originality of the study. AIM To reintroduce 'concurrent analysis' (CA) - a method of synthesising relevant literature with primary data. DISCUSSION CA treats all data as primary data. To illustrate the technique, the authors synthesise relevant literature with findings from a doctoral study of patients' experiences of vascular access devices. CONCLUSION CA raised new questions that would otherwise have remained unasked. For example, it revealed cultural differences in the way patients react to suboptimal treatment. IMPLICATIONS FOR PRACTICE Nurse researchers are best placed to influence policy and practice when they can articulate the transferability of their findings. CA is a practical method of achieving this.
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Affiliation(s)
| | - Austyn Snowden
- Mental health, School of Health and Social Care, Edinburgh Napier University, Scotland
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Kelly LJ, Snowden A, Paterson R, Campbell K. Health professionals' lack of knowledge of central venous access devices: the impact on patients. ACTA ACUST UNITED AC 2019; 28:S4-S14. [PMID: 31348702 DOI: 10.12968/bjon.2019.28.14.s4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope. AIM the study objective was to uncover the global, cross-disease experience of patients with CVADs. METHOD an online survey was sent to an international sample of people living with CVADs. FINDINGS 74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice. CONCLUSION clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.
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Affiliation(s)
- Linda J Kelly
- Clinical Nurse Advisor (Intravascular Therapies), Vygon UK Ltd, Scotland, Northern Ireland, North of England
| | - Austyn Snowden
- Professor in Mental Health, Edinburgh Napier University, Edinburgh
| | | | - Karen Campbell
- Macmillan Senior Learning and Development Manager, Edinburgh
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Ryan C, Hesselgreaves H, Wu O, Moss J, Paul J, Dixon-Hughes J, Germeni E. Patient acceptability of three different central venous access devices for the delivery of systemic anticancer therapy: a qualitative study. BMJ Open 2019; 9:e026077. [PMID: 31292176 PMCID: PMC6624052 DOI: 10.1136/bmjopen-2018-026077] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Three types of central venous access devices (CVADs) are routinely used in the delivery of intravenous systemic anticancer therapy (SACT): peripherally inserted central catheters (PICCs), subcutaneously tunnelled central catheters (Hickman-type devices) and totally implantable chest wall ports (Ports). This qualitative study, nested within a multicentre, randomised controlled trial, sought to explore patient acceptability and experiences of the three devices. DESIGN Eight focus groups were audio-recorded, transcribed and thematically analysed. SETTING Six outpatient cancer treatment centres in the UK. PARTICIPANTS Forty-two patients (20 female, mean age 61.7 years) who had taken part or were taking part in the broader trial. INTERVENTION As part of the larger, randomised controlled trial, participants had been randomly assigned one of three CVADs for the administration of SACT. RESULTS Attitudes towards all three devices were positive, with patients viewing their CVAD as part of their treatment and recovery. Participants with PICCs and Hickmans tended to compare their device favourably with peripheral cannulation. By comparison, participants with Ports consistently compared their device with PICCs and Hickmans, emphasising the perceived superiority of Ports. Ports were perceived to offer unique psychological benefits, including a greater sense of freedom and less intrusion in the context of personal relationships. CONCLUSIONS Patient experiences and preferences have not been systematically used to inform policy and practice regarding CVAD availability and selection. Our research identified patterns of patient device preferences that favoured Ports, although this was not universal. Results of this study could improve support for patients and offer greater scope for incorporating patient perspectives into decision-making processes. TRIAL REGISTRATION NUMBER ISRCTN44504648.
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Affiliation(s)
- Caoimhe Ryan
- School of Social Sciences, University of Dundee, Dundee, UK
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | | | - Olivia Wu
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Jonathan Moss
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - James Paul
- Cancer Research UK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Judith Dixon-Hughes
- Institute of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Evi Germeni
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
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Bellmann-Strobl J, Pach D, Chang Y, Pasura L, Liu B, Jäger SF, Loerch R, Jin L, Blödt S, Brinkhaus B, Ortiz M, Reinhold T, Roll S, Binting S, Paul F, Witt CM, Shi X. The effectiveness of acupuncture and mindfulness-based stress reduction (MBSR) for patients with multiple sclerosis associated fatigue – A study protocol and its rationale for a randomized controlled trial. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
OBJECTIVES The aim of the study was to explore women's motivations for participating in a clinical trial and to evaluate how financial compensation impacts women's explanations for participation. DESIGN, SETTING AND PARTICIPANTS Semistructured interviews were conducted face to face or by telephone with 25 of 220 women who participated in a pragmatic randomised trial for app-administered self-care acupressure for dysmenorrhoea (AKUD). Of these 25 women, 10 had entered AKUD knowing they would receive a financial compensation of €30. A purposive sampling strategy was used. RESULTS Women had a long history of seeking help and were unsatisfied with the options available, namely painkillers and oral contraceptives. While interviewees were open to painkillers, they were uneasy about taking them on a monthly basis. The AKUD trial offered the possibility to find an alternative solution. A second reason for participation was the desire to add a new treatment to routine medical care, for which the interviewees considered randomised trials a prerequisite. The financial incentive was a subsidiary motivation in the interviewees' narratives. CONCLUSIONS Our results contribute to the ongoing discussion of the impact of financial compensation on research participants' assessment of risk. The interviewed women considered all research participants able to make their own choices regarding trial participation, even in the face of financial compensation or payment of study participants. Furthermore, the importance of clinical trials providing new treatments that could change medical practice might be an overlooked reason for trial participation and could be used in future recruitment strategies.
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Affiliation(s)
- Susanne Blödt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Christine Holmberg
- Institute of Public Health, Charité—Universitätsmedizin Berlin, Berlin, Germany
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